Mumbai: The high number of deaths over the weekend at the Nanded government hospital, mainly due to shortage of medical staff and medicines, has highlighted the role of the Directorate of Medical Education and Research (DMER). Since 2014, a series of measures have restricted the role of the once-powerful institution, leading to serious gaps in the state’s health system.
Until 10 years ago, the DMER was the central agency for the purchase of medicines and equipment for all state hospitals in the state with an attractive budget of approximately $6000 crores. “The DMER used to fix the contract rates and suppliers of medicines and accordingly the hospital deans would order and purchase them as per need,” said Dr Pravin Shingare, former director of the DMER.
However, in 2013, the then public health minister decided to cut the powers of the DMER and created two purchasing authorities, the DMER and the director of public health. This often resulted in different prices for the same set of medications and equipment because the contractors would be different, leading to a large number of departmental inquiries. In 2015, the government, then led by Devendra Fadnavis, decided to appoint a completely separate corporation for procurement of medicines and equipment under Haffkine, similar to Tamil Nadu Medical Services Corporation (TNMSC), which alone handles the purchase of medical equipment. and drugs in public facilities.
“We decided on Haffkine Bio-Pharmaceutical Corporation Limited to purchase 2,500 types of medicines and equipment for government medical colleges and all other hospitals working under various departments. The government even finalized an administrative structure to manage this corporation, but no full-time appointments have been made till date,” Shingare said.
An official at a government medical college said, on condition of not being quoted, that deans were authorized to spend only 10 percent of the budget on procurement, while the remaining 90 percent of the budget was automatically transferred to Haffkine. for a particular institution’s requirements. But this is only on paper. “We kept sending our budget money to Haffekine, but we never received our equipment or medications on time.” On Friday, the government revised the purchasing power of deans to 40 percent. After the deaths in Nanded, the state has also given district collectors the authority to utilize 100% of the medical funds available in the District Planning Development Committee (DPDC) for the purchase of medicines. Deans can now approach the collector if they need medicines and equipment without waiting for higher approval.
However, Dr Abhay Shukla, national coordinator of Jan Swasthya Abhyan, a network of civil society organizations and people’s movements focused on public health, termed Friday’s decision as instinctive and said centralized procurement was a better option. . “Multiple purchasing agencies increase the cost of purchasing medicines and also increase corruption. We need to return to a centralized purchasing system as it was with the DMER,” he said.
Also cut the power of appointments
Although new medical colleges have been set up in the state in the last five years at Satara, Nandurbar, Sindhudurg, Alibaug and Osmanabad, taking Maharashtra’s total to 26 state medical colleges, there is a shortage of teachers in most places. “While medical positions were increased, medical schools were added, the system forgot to create new positions and hire labor. Every time there is an inspection by the National Medical Commission (NMC), professors from other government medical colleges are hurriedly brought in to show their full strength and pass the inspection smoothly,” said a senior doctor from one of the colleges. medical schools, requesting not to be cited.
“It has become a pattern that we are transferred mid-term so that government colleges can undergo National Medical Commission (NMC) inspections. This affects not only the teaching process but also our family life.” Lack of timely promotions, ban on private practice and shortage of medicines and diagnostic equipment in government hospitals were the reasons why many doctors, despite their best intentions, left the public healthcare system, he added.
While recruitment of medical teachers is done through the Maharashtra Public Service Commission, lengthy departmental processes and potential court cases cause inordinate delays in each round of appointments. Until 2019, the DMER had the power to grant temporary promotions and hire medical professors, but even this was withdrawn, Dr Shingare said. “People who were promoted during my tenure were demoted after my retirement,” he said, adding that one way to ensure there were no gaps in recruitment would be to restore the DMER’s powers to recruit and promote.